André PratteMy View of Our Montreal

The federal government and the provinces and territories have been squabbling about health care financing for months. The provinces are demanding that Ottawa increase its Canada Health Transfer (CHT) by a whopping $28 billion a year, an unrealistic amount. The Trudeau government says that it is willing to increase its transfers, but it wants to ensure that the money is spent to improve the system’s performance.

While politicians bicker, sick Canadians, including children, spend days in the emergency wards waiting to see a doctor or to get a room on the floors. They wait months to see a specialist. They wait months, if not years, for a surgery. Despite the billions and reforms thrown at it, access to care remains a huge problem.

The provinces and territories are right that rapidly increasing costs, population ageing and staff shortages require additional financial resources. Considering the favorable long-term fiscal prospects of the federal treasury, some of the money should come from Ottawa.

In exchange for the additional funds, Canada’s Health minister, Jean-Yves Duclos, has asked the provinces to agree on national targets and indicators. “Before we come to the means that we need to achieve some ends, we need to agree on the ends and to speak publicly about them”, Duclos said last month in his usual, cryptic language.

Indeed, the federal minister has not clearly explained what he means by that. Does “agree on the ends” mean an agreement on national standards? Because health care is a provincial jurisdiction, some provinces, including Quebec of course, will never agree to that.

What is the meaning of “speaking publicly” about the outcomes? Should provinces report to the federal government, or to the public?

The situation in Canada’s hospitals and clinics is dire; this is not time for posturing. Politicians should try harder to find a compromise solution. With all parties acting in good faith, an agreement is achievable.

Afterall, Ottawa and the provinces and territories did agree on financing, common goals and reporting improvements in the 2004 “10-year Plan To Strengthen Health Care” and again in 2017, with the “Common Statement of Principles on Shared Health Priorities”. Both accords recognized Quebec’s specific situation through the “asymmetrical federalism” principle.

“While politicians bicker, sick Canadians, including children,

spend days in the emergency wards.”

In the 2017 “Statement of Principles”, governments agreed on such goals as “Enhancing access to palliative and end of life care at home or in hospices”, “Increasing support for caregivers”, and “Enhancing home care infrastructure, such as digital connectivity, remote monitoring technology and facilities for community-based service delivery.” The needs are so obvious, what is so difficult in updating that list?

As far as reporting goes, again, the 2017 agreement set the proper mechanisms that would allow Canadians to see whether the situation is improving or not in their province and in the country overall, without forcing provinces and territories to report directly to the federal government. “Federal, Provincial and Territorial Health Ministers agree to work collectively and with the Canadian Institute for Health Information (CIHI) to develop a focused set of common indicators to measure pan-Canadian progress on the agreed priorities of mental health and addictions, and home and community care, to be reported on annually to Canadians”, the agreement states.

Twelve indicators have since been developed and are now published by the Institute at regular intervals. In other words, the 2017 agreement did produce concrete results, although the feds chose to conclude separate financing deals with each province and territory, contrary to the pan-Canadian accord of 2004.

Admittedly, the provincial governments have not been doing a great job at managing their health care systems; therefore, Ottawa’s hesitation towards sending billions more down the drain is understandable. Yet, for the federal government to lecture provinces on the need to achieve results is a bit rich, considering Ottawa’s inept management of its own jurisdictions (think Phoenix, passports, immigration…).

Consequently, instead of pumping their muscles in a puerile attempt to score political points, federal, provincial and territorial politicians should start negotiating seriously on the basis of a few, basic principles:

• Health care is a provincial jurisdiction. It is for each province to decide how to manage its health care system, within the Canada Health Act’s parameters;

• Taking into account population growth and ageing, and technological advances, health care costs will continue to grow at least 5%-6% per year;

• Considering its positive, long-term fiscal prospects, the government of Canada should increase its share of health care funding;

• The Canada Health Transfer’s growth should be set at 5-6% a year for a duration of 10 years;

• Provinces and territories should commit to work with the CIHI to develop a wide range of national performance indicators.

• Provinces and territories should agree to report regularly on their health care system’s performance, in a format intelligible to their citizens.

At the end of 2022, NDP leader Jagmet Singh threatened to pull out of his agreement with the Trudeau government if there continued to be no movement from the Liberals on the health care front: “If we don’t see action on health care, we absolutely reserve the right to withdraw our support,” Singh said at a press conference.

“Provinces and territories should commit to work with the

Canadian Institute of Health Information to develop

a wide range of national performance indicators.”

Mr. Singh is right to be impatient. However, he has not defined what “action” means exactly. Furthermore, his party is part of the problem. In exchange for supporting the government, the NDP has required that the feds develop new, costly, dental care and pharmacare programs. This is typical: politicians love to launch new programs much more than making sure current programs work properly. Pharmacare, in particular, will be hugely expensive. Do Canadian governments really have the means to finance such a project, while public health care systems are bursting at the seams?

I’ve been writing on the situation of health care in Canada for close to 40 years; it has never been this bad. So, politicians, let’s make a deal. Fast.

André Pratte is a Senior Fellow, Graduate School of Public and International Affairs, University of Ottawa.